A multicenter analysis of safety and outcome of removal of a fully covered self-expandable metal stent during ERCP

Background: Fully covered self-expandable metal stents (FCSEMSs) have been used for palliation of both malignant and benign biliary strictures. Limited data are available about safety and outcome of endoscopic removal of these stents. Objective: To evaluate safety and efficacy of endoscopic removal of FCSEMSs. Design: Retrospective review of patients who underwent endoscopic removal of Viabil FCSEMSs. Setting: Four centers with experience in using FCSEMSs. Patients: Thirty-seven patients who had stents endoscopically removed. Intervention: ERCP with endoscopic removal of FCSEMSs. Main Outcome Measurements: Feasibility, safety, and complications associated with endoscopic removal of FCSEMS. Results: All 37 stent removal attempts were successful and were achieved without difficulty. Indwelling stent-related complications occurred in 4 of 37 patients, including secondary strictures in 3 and minor bile leak in 1. Two of 3 secondary strictures occurred at the distal stent margin of oversized intraductal stents, and another stricture occurred at a proximal stent margin of an oversized transpapillary stent. One case of minor confined intratumoral bile leak also occurred in a patient with metastatic urothelial cancer of the bile duct. All of these cases were successfully treated with repeat stenting and resolved without sequelae. No free perforations or significant bleeding occurred. Limitations: Retrospective study. Conclusion: Endoscopic removal of Viabil FCSEMSs placed for benign or malignant conditions is feasible and easily accomplished. Secondary strictures may be found at the time of stent removal or with a delayed presentation in patients with oversized stents who may require repeat stent placement.